Frontiers in pediatrics · 2026
Independent risk factors for clinically significant acute poisoning in children presenting to the emergency department: a 4-year cohort study of 2,345 cases.
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Zhao Zhai, Liang Xingsi, Wang Xiao, Guo Weili, Geng Wenjin
Аннотация
BACKGROUND: Acute poisoning is a major pediatric emergency department (ED) presentation, yet evidence-based tools for early risk stratification at triage remain limited. This study aimed to characterize epidemiological trends and identify independent risk factors for clinically significant poisoning (Poisoning Severity Score [PSS] ≥ 2) in children.
METHODS: We conducted a retrospective cohort study of 2,345 children (<18 years) with acute poisoning (2021-2024). Patients were stratified into mild (PSS 0-1) and clinically significant (moderate-to-severe) groups. Multiple imputation handled missing data. Multivariable logistic regression identified independent risk factors. Model discrimination and calibration were assessed using the Area Under the Receiver Operating Characteristic curve (AUC-ROC) and Hosmer-Lemeshow test. Patient-centered outcomes (acute organ dysfunctions) were systematically analyzed.
RESULTS: Over 4 years, the poisoning spectrum shifted from agricultural chemicals toward psychotropic drugs (18.5%-31.2%). Clinically significant poisoning occurred in 422 patients (18.0%). Independent risk factors for moderate-to-severe outcomes were: age >12 years (aOR 2.34), intentional self-harm (aOR 3.12), pre-hospital delay >6 h (aOR 2.78), multiple-agent exposure (aOR 2.15), exposure to agricultural herbicides (aOR 5.45), and psychotropic drugs (aOR 3.86). The model achieved an outstanding AUC-ROC of 0.892 (95% CI: 0.864-0.920). Clinically significant poisoning (PSS ≥ 2) was strongly associated with patient-centered organ injury, including acute respiratory failure (26.5% vs. 0.1%, P < 0.001), toxic encephalopathy (22.5% vs. 0.0%, P < 0.001), and Multiple Organ Dysfunction Syndrome (MODS, 12.8% vs. 0.0%, P < 0.001) compared to mild cases. These cases required PICU admission (71.1%) and blood purification (44.1%) significantly more often. Mortality was 1.2% (28/2,345), occurring exclusively in the PSS ≥ 2 group.
CONCLUSION: Readily identifiable risk factors-age >12 years, self-harm, delay >6 h, multiple-agent exposure, and exposure to herbicides or psychotropics-independently predict clinically significant pediatric poisoning. The PSS ≥ 2 classification correlates tightly with acute organ dysfunction and Multiple Organ Dysfunction Syndrome (MODS).
METHODS: We conducted a retrospective cohort study of 2,345 children (<18 years) with acute poisoning (2021-2024). Patients were stratified into mild (PSS 0-1) and clinically significant (moderate-to-severe) groups. Multiple imputation handled missing data. Multivariable logistic regression identified independent risk factors. Model discrimination and calibration were assessed using the Area Under the Receiver Operating Characteristic curve (AUC-ROC) and Hosmer-Lemeshow test. Patient-centered outcomes (acute organ dysfunctions) were systematically analyzed.
RESULTS: Over 4 years, the poisoning spectrum shifted from agricultural chemicals toward psychotropic drugs (18.5%-31.2%). Clinically significant poisoning occurred in 422 patients (18.0%). Independent risk factors for moderate-to-severe outcomes were: age >12 years (aOR 2.34), intentional self-harm (aOR 3.12), pre-hospital delay >6 h (aOR 2.78), multiple-agent exposure (aOR 2.15), exposure to agricultural herbicides (aOR 5.45), and psychotropic drugs (aOR 3.86). The model achieved an outstanding AUC-ROC of 0.892 (95% CI: 0.864-0.920). Clinically significant poisoning (PSS ≥ 2) was strongly associated with patient-centered organ injury, including acute respiratory failure (26.5% vs. 0.1%, P < 0.001), toxic encephalopathy (22.5% vs. 0.0%, P < 0.001), and Multiple Organ Dysfunction Syndrome (MODS, 12.8% vs. 0.0%, P < 0.001) compared to mild cases. These cases required PICU admission (71.1%) and blood purification (44.1%) significantly more often. Mortality was 1.2% (28/2,345), occurring exclusively in the PSS ≥ 2 group.
CONCLUSION: Readily identifiable risk factors-age >12 years, self-harm, delay >6 h, multiple-agent exposure, and exposure to herbicides or psychotropics-independently predict clinically significant pediatric poisoning. The PSS ≥ 2 classification correlates tightly with acute organ dysfunction and Multiple Organ Dysfunction Syndrome (MODS).